'Because the world is backward'

There's a masterful piece in today's New York Times about the Mini-Mental Status exam. Adapted from Bernard Cooper's book, it's the story of a doctor administering a battery of questions to an aging man, while his son looks on:
First she asked my father to tell her the date. I silently answered along. He got it right. I was off by a couple of days. I scooted my chair closer. Now I had something to prove. I felt as if my father and I were opponents on a quiz show.

"What state are we in?" "City?" "Hospital?" "Floor?"

Not until she whispered "Bernard" did I realize that I'd been muttering answers under my breath. But I was sure my father hadn't heard me. And anyway, I got them right. Dad, on the other hand, didn't know what floor we were on. But he probably would have known it was the third if he had been the one to push the elevator button instead of me. The mechanics of recall are delicate, so iffy and contingent.

My father lowered his head and laced his fingers together in his lap. He had the shamed, inward look of a man who knows he has blundered but doesn't know how.

"Mr. Cooper?" she asked. "Are you ready to continue?"

My father nodded. His head seemed heavy, as if with answers that would soon elude him.

"Spell 'world' backward," the doctor said.

"Why 'world'?" Dad asked, peering over his glasses.

Because the world is backward, I said to myself. Laws are repealed. Iron rusts. Logic unravels.

The trio continues processing the questions, only to get hung up by on a pen. Cooper captures the horror of forgetfulness, the absurdity of this test, and also its strange appeal.

These days I'm riding along with EMT's in ambulances. The crews are very efficient and well trained, and I've learned a lot about their jobs. To return the favor, I try to help out around the truck, or expand upon part of a patient's workup -- EKG interpretation, the differential for syncope, etc.

Just recently we were called for an assault on a young man, it turns out he was hit over the head by "some dude", at the bus station. He couldn't recall much about it, and had had a few drinks -- but there was something odd about his affect, on top of it. Aside from a small head laceration, his physical exam was unremarkable. But when the cops disclosed to us that the patient didn't know where he was, I launched into the Folstein (another name for the above-mentioned mini mental status exam).

The EMT's, and even the patient, were thrilled with the questions:
"Holy crap, doc!" one paramedic exclaimed. "I had the wrong date today."

"So I can say 'No ifs, ands, or buts', huh? Is grammar really that important?"

I sensed the test was not fulfilling its diagnostic usefulness. So I ditched the rest of the Folstein exam, and, egged on by my audience, went for broke:
"Okay, one last question. You know the expression, 'people in glass houses shouldn't throw stones' -- what does that mean to you?"

The group was stunned. Here was something not pondered in many bus stations. After a moment, the patient abstracted the meaning of the maxim.

The excitement faded, and the crew returned to their paperwork. Perhaps they had a new appreciation of how brain function can be assessed with a few simple questions. At the very least, they'd found a new diversion to challenge each other, and the patients they'd encounter that night.